A Case of Postoperative Cholangitis after Pylorus-preserving Pancreatoduodenectomy Successfully Treated by the Change of Reconstruction

The case study is a 56-year-old woman who had come to hospital complaining of fever and abdominal pain. She underwent pylorus-preserving pancreatoduodenectomy using Imanaga (Billroth I) reconstruction for the treatment of lower bile duct carcinoma. Because of postoperative recurrences of cholangitis and hepatophyma, abscess drainage was provided. There was nothing remarkable with the serum ALP levels nor with the upper gastrointestinal rentogenography; in addition, 99mTc-PMT hepatobiliary scintigraphy failed to demonstrate any stricture at the site of the choledocho-jejunostomy or bile stasis in the proximal jejunum loop. The patient began to take meals, only to manifest symptoms of cholangitis, for which intra-arterial infusion of antibiotics was ineffective. We assumed that the cholangitis was probably due to reflux of food into the biliary tract, and so the reconstruction was changed from Billroth I to Billroth II. No recurrences of cholangitis have occurred for the last six months after the re-operation.